ACOSOG is a cooperative group comprised of practicing medical, radiation, and surgical oncologists, diagnostic imagers, patient advocates, pathologists, basic scientists, nurses/CRAs, statisticians, and other healthcare professionals representing academic and community practices throughout the U.S. The purpose of ACOSOG is to develop and evaluate innovative cancer therapies in which the surgical management of cancer patients plays a key role. ACOSOG Is dedicated to Improving the care of the surgical oncology patient through an Innovative clinical research program addressing three specific aims: 1. To test novel therapies that may increase response and cure rates and reduce morbidities and disabilities associated with cancer care 2. To conduct basic science studies in conjunction with clinical trials to better understand the biologic basis of diseases and treatments. 3. To support Individual members and investigator networks to accrue patients to trials and fulfill the scientific mission of ACOSOG. The scientific portfolio of ACOSOG is focused on investigations addressing three scientific aims for ACOSOG trials: 1) to investigate novel surgical and targeted therapies to maintain oncologic outcomes while reducing toxicities and disabilities and Improving quality of life;2) to enhance the accuracy of risk stratification through imaging and molecular profiling;and 3) to Improve overall response rates and monitor Individual responses through the application of neoadjuvant therapies. The scientific agenda is established by the Basic and Translational Science Committee and the three Disease Committees: Breast, Gastrointestinal (GIST, pancreas, and rectum), and Thoracic (lung and esophagus) and maintained and prioritized by the ACOSOG Peer Review Committees. A multidisciplinary approach to the scientific agenda is accomplished through the comprehensive integration of all modalities and disciplines. Membership interests, needs, and oversight are attended to through the actions of seven Administrative Committees. To accomplish the goals of ACOSOG, the group conducts clinical trials and correlative studies using an infrastructure consisting of three critical components Including: 1) the Operations and Membership Center (OMC) located in Durham, NC, within the Duke Clinical Research Institute;2) the Statistics and Data Center (SDC) located In Rochester, MN, within the Mayo Clinic Cancer Center;and 3) the Central Specimen Bank (U24 # 5 U24 CA114736) located in St. Louis, MO, within the Washington University.